bricklayers l1 of md, va & dc - redacted hw

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//O|/Joseph/Bricklayers%20Local%201%20of%20MD,%20VA%20&%20DC/Approval%20letter%20sent%2011-23-2010.htm[10/31/2011 9:47:10 AM]

rom: Botwinick, Alexandra (HHS/OCIIO)ent: Tuesday, November 23, 2010 1:46 PM

To: '[email protected]'ubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711

mportance: High

Attachments: Updated Jan 1 Approval Letter .pdf

ood Afternoon,

hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act

ection for Bricklayers Local 1 of MD, VA and DC. HHS has reviewed your application and made its

etermination. Please see the attached letter.

lease confirm receipt of this letter by replying to this e-mail address with a copy to [email protected]

lease let me know if I can be of further assistance.

incerely,

Alexandra Botwinick

ffice of Oversight

HHS/[email protected]

BRICK L1 MD:000001
mailto:[email protected]:[email protected]


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THE SEGAL COMPANY1920 N Street NW Suite 400 Washington, DC 20036-1659

T 202.833.6400 F 202.833.6490 www.segalco.com

Benefits, Compensation and HR Consulting OFFICES THROUGHOUT THE UNITED STATES AND CANADA

Founding Member of the Multinational Group of Actuaries and Consultants, a global affiliation of independent firms

APPLICATION FOR WAIVER OF RESTRICTED ANNUAL LIMITSBricklayers Local 1 of MD, VA & DC Health and Welfare Fund

ATTACHMENT #2

The following is a finding of the financial position and cost-projections for the BricklayersLocal 1 of MD, VA & DC Health and Welfare Fund:

-At the beginning of 2010, Plan assets net of liabilities were projected to be asof December 31, 2010 (including in merger assets). This assum operating loss of ; howe date operating losses through August 2010have already exceeded $700,000, due in large measure to employment declines. In this samestudy, which preceded enactment of PPACA and the Plans effective date forcompliance, the Plan was projected to incur further losses in 2011 and 2012 of and , respectively, which would r nly 9 months of reserves by the end of2012. A 2010 loss in excess of the projected would cause an even greater decline inthe level of reserves.

-The projected cost of compliance with the PPACA restricted annual limits requirement(including increasing the existing overall benefit limits for both the Standard Plan andMaterial Handlers, and increasing the current prescription drug sublimit limits, to$750,000) is projected to cost the Fund in 2011. On a per active employee basis,this would increase Plan costs by per hour. In addition to the foregoing, the Plan isprojected to incur costs of in 2011 resulting from the age 26 mandate andcompliance with the MHPAEA. As mentioned in the g paragraph, the 2011projected benefit expenditures are in addition to the loss originally projected for2011.

-As a result of quotes received from five insurance providers, it has been determined that

the 2011 cost of a stop-loss insurance policy with a specific stop-loss deductiblewould range from per contract per month. On an annual basis, theresultant stop-loss premium would range from approximately Inaddition to the cost of whichever policy selected, the Fund would also incur the risk

e to claim rial Handlers over and above their current annual limit ofup to the deductible.

BRICK L1 MD:000002


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Page 2

-To finance these increase costs, possible Plan changes may ha a combinationof a substantial increase in the calendar year deductible (from ) and a decrease

in the coinsurance paid by the Plan (from ).1/1/2010

12/31/20101/1/2011- 12/31/2011

2010 Premium

rate equivalent

Requested Annual Maximum

- Premium rate equivalent

with requested Annual

Medical Limit for Standard

Plan/ Annual Medical

Limit for MaterialHandlers/Unlimited Lifetime

Maximum

Annual Maximum if

Waiver not granted -

Premium rate equivalent

with $750K Annual

Medical Limit for both the

Standard Plan & MaterialHandlers/ Unlimited

Lifetime Maximum

Standard

Plansingle

familysinglefamily

single

family

Material

Handlerssingle

familysinglefamily

single

family

Note: Premium rate equivalent are based on COBRA rates minus the administrative charge.

7350198_6.DOCX

BRICK L1 MD:000003


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Pages 4 through 131 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -(b)(4)

BRICK L1 MD:000004


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//O|/Joseph/Bricklayers%20Local%201%20of%20MD,%20VA%20&%20DC/Confirmation%20of%20Approval%2011-24-2010.htm[10/31/2011 9:47:1

rom: Kathy Cole [[email protected]]ent: Wednesday, November 24, 2010 8:00 AM

To: Botwinick, Alexandra (HHS/OCIIO)Cc: OCIIO Oversight

ubject: RE: Waiver of the Annual Limits Requirements of PHS Act Section 2711

ollow Up Flag: Follow uplag Status: Redhank you very much news to be thankful for this week.

athy Cole

ccount Executive

EMGroup Inc

01-839-8800 x802

[email protected]

rom: Botwinick, Alexandra (HHS/OCIIO) [mailto:[email protected]]ent: Tuesday, November 23, 2010 1:46 PMo: Kathy Cole

ubject: Waiver of the Annual Limits Requirements of PHS Act Section 2711mportance: High

ood Afternoon,

hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act

ection for Bricklayers Local 1 of MD, VA and DC. HHS has reviewed your application and made its

etermination. Please see the attached letter.

lease confirm receipt of this letter by replying to this e-mail address with a copy to [email protected]

lease let me know if I can be of further assistance.

incerely,

Alexandra Botwinick

ffice of Oversight

HHS/[email protected]

BRICK L1 MD:000005


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BRICK L1 MD:000006


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BRICK L1 MD:000007


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BRICK L1 MD:000008


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BRICK L1 MD:000009


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1 Welfare Fund - Waiver Application

//O|/...layers%20Local%201%20of%20MD,%20VA%20&%20DC/Requst%20for%20additional%20info%20response%2011.17.10.htm[10/31/2011 9:47

rom: Kathy Cole [[email protected]]ent: Wednesday, November 17, 2010 4:45 PM

To: Habit, Sandra (HHS/OCIIO)Cc: [email protected]; [email protected]: BAC1 Welfare Fund - Waiver Application

mportance: High

Attachments: BAC Local 1 HW - OCIIO Waiver Program - Application - Attachment#2 v2.PDFandra please see attached, a revised attachment 2 to the waiver application for the Bricklayers Local No 1 of MD, VA an

C Health & Welfare Fund. The information you requested on Tuesday 11/16/2010 has now been included.

lease do not hesitate to contact me directly with any additional requests or questions you may have.

ncerely,

athy Cole

ccount Executive

EMGroup Inc

01-839-8800 x802

[email protected]

BRICK L1 MD:000010


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BRICKLAYERS LOCAL 1 OF MD, VA AND DC

HEALTH AND WELFARE FUNDFund Office: GEMGroup, Administrator, The Constellation Centre One, 6009 Oxon Hill Road, Suite 416, Oxon Hill, MD 20745

Phone: (301) 839-8800 / 1-800-424-2707 / Fax: (301) 839-8812

SUMMARY OF MATERIAL MODIFICATION

October 2009

Start of addressLine 1Line 2Line 3City, State, Zip

Dear Participant:

The Trustees are pleased to advise you of the following improvements in your Plan of Benefits.

This is to serve as notification of recent and upcoming changes that have been made to your current SummaryPlan Description. Please be advised of the following:

Comprehensive Major Medical Lifetime Maximum

The Comprehensive Major Medical Lifetime Maximum has been increased from to $750,000.This change does not affect the Material Handler comprehensive Major Medical aximumwhich will remain at .

This Plan change is effective January 1, 2010.

Annual Family Prescription Drug Maximum

The annual prescription drug maximum per family has been increased from per yearThis plan change is retroactive to July 1, 2009.

If your family has already met the calendar year maximum, please submit copies of original purchasereceipts with necessary prescription details, along with the attached claim form, directly to SAV RX forprocessing. If copies of original purchase receipts are not available, pharmacy printouts with completeprescription purchase details can also be submitted with the attached claim form. All coveredprescription purchases made after July 1, 2009, will be considered for benefits based on the new annualmaximum.

The Trustees will continue to try and improve your benefits whenever it can be done prudently.

You should maintain this Summary Material Modification with your copy of the current Summary PlanDescription in a safe place for your future reference. If you have questions regarding these changes you cancontact the Fund Offices Claims Department at 1-800-242-8923.

BRICK L1 MD:000011


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BRICK L1 MD:000012


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rom: Kathy Cole [[email protected]]ent: Saturday, November 06, 2010 10:57 AMo: HHS HealthInsurance (HHS)

Cc: [email protected]; [email protected];[email protected]; [email protected]: WAIVER

Attachments: RX drug ann increase and lifetime max increase 1009.doc;

AC1 SPD 04012008.pdf; MX-M450N_20101106_093241.pdf

o whom it may concern:

On behalf of the Bricklayers Local 1 of MD, VA and DC Health & Welfare Fund, please accept this application anupporting material, pursuant to OCIIO Sub-Regulatory Guidance 2010-1, for waiver of the restricted annual dollarmit set forth under PPACA. If you have any questions, please do not hesitate to contact the undersigned.

hank you,

Kathy ColeAccount ExecutiveGEMGroup Inc

01-839-8800 [email protected]

BRICK L1 MD:000014

bricklayers l1 of md, va & dc - redacted hw

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